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Knowing Your Stats: Using Your Data to Improve Financial and Clinical Outcomes
September 2017
Overview
Identify key CMS sites and reports
Understand the role an agency’s EMR plays in reporting and data analysis
Identify benchmarks key to monitoring an agency’s success, and how to track these
Identify how to use data to detect potential organizational issues
Identify how to use data to prioritize strategic initiatives
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Knowing Your Stats:
CMS Data
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CASPER Reports
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Two Parts OBQI (Outcome Based Quality Improvement)
OBQM (Outcome Based Quality Management)
OBQI Outcomes Report
Patient Tally Report
Agency Patient-Related Characteristics Report
OBQM Potentially Avoidable Event Reports
Access CASPER Report: CMS OASIS System Welcome Page
Select CASPER Reporting link
CASPER Reports: OBQI
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Outcomes Report:
37 risk adjusted outcome measures
Compares agency to prior years and national averages
Patient Tally Report:
Individual case information included in Outcomes Report
Agency Patient-Related Characteristics Report:
Snapshot of agency patient characteristics
Includes:
Demographics
Diagnosis
Hospitalization risks
Discharge Disposition
CASPER Reports: OBQM
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Potentially Avoidable Event Report:
Identifies negative outcomes form OASIS data
Obtained from SOC/ROC data and Transfer/Discharge data
Marks potential inadequate care issues
Agency needs to conduct own analysis to identify if there were actual care issues impacting the outcome
Graphical
Agency-level comparison to reference sample
Tabular
Identifies actual patients with declines
Home Health Compare
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Publically reported OASIS outcomes Allows for consumers and referral sources to be more informed when
selecting a home health agency
Allows agencies to compare themselves to competitors
Data is on a rolling year approximately 6-9 months old Current data shows 1/1/16-12/31/16
Includes HHCAHPS survey data Representative of patient satisfaction with the service received from an
agency
HHCAHPS data updated quarterly
Outcome comparison to state/national averages
Access:
www.medicare.gov/HomeHealthCompare
Five Star Ratings
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Summarizes performance using easy to identify rating (stars) on 5 star scale
Comparison to other agencies with the state
Two categories Quality of care star ratings
Patient experience of care star ratings
Risk Adjusted
Statistically clustered to identify groups by mean of each cluster Majority of agencies are in the middle (3 to 3 ½ stars)
Data updated for experience of care is updated quarterly
Access: www.medicare.gov/HomeHealthCompare
Located on first page
Hospice Compare
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Just launched on August 16, 2017
Hospices were given the opportunity to preview their scores 30 days prior to implementation
Includes seven quality measures derived from Hospice Item Set (HIS) submissions
Broken into two categories: Patient Preferences
Managing Pain and Treating Symptoms
Anticipated that Hospice CAHPS outcomes data will be included in winter 2018
Outcome comparison to state/national averages
Access:
www.medicare.gov/HospiceCompare
PEPPER
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Program for Evaluating Payment Patterns Electronic Report:
Comparative data report summarizing agency Medicare claims data
Released annually in July
Three year claim data summary
Comparison to nation, MAC jurisdiction, state
Target areas are high risk areas for improper Medicare payment
Includes percent and percentile information
Percent is agency specific
Target item: reported number/total number
Percentile is comparison to all
80th percentile is target
Access (only by CEO/Administrator/Compliance Officer):
pepperresources.org
PEPPER Target Areas
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At Risk is above 80th Percentile: Average Case Mix
Risk over-coding in clinical/functional status
Average Number of Episodes
Risk overutilization: not medically necessary/skilled
Episodes with 5 or 6 visits
Risk minimum number of visits to obtain HHRG avoid LUPA
Non-LUPA payments
Risk focus on visits to prevent LUPA
High Therapy Utilization Episodes (+20)
Risk over utilization not medically necessary
Outlier Payments
Risk over-coding of clinical/functional status
PEPPER
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As of February 2017, only 25% of providers nationwide had accessed their 2016 PEPPER
Since the 2017 PEPPER was released on July 14, 2017, only 23 of 123 New York agencies have retrieved their report (18.7%)
Access (only by CEO/Administrator/Compliance
Officer): pepperresources.org
HH VBP Interim Payment Report
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Released quarterly to VBP agencies
Includes: Agency quarterly performance on VBP indicators
Identifies state achievement and benchmark scores
Identifies agency baseline score from 2015
Identifies agency scoring on each outcome
Identifies agency overall TPS Score
Doesn’t Include Agency comparison to all state providers in cohort
Financial impact
Access Report: Portal.CMS.gov - HHVBP Secure Portal
Knowing Your Stats:
How to use your data?
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How to Use Your Data:
Casper Reports:
Identify agency trends over year time frame
Identify outcomes variances from comparison group
Identify process measures that may impact outcomes
Identify areas for further investigation
Identify target outcomes for performance improvement
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How to Use Your Data:
Identify agency outcomes
Compare outcomes to national/state or competitors
Identify areas for improvement
Trend data for improvement
Use as marketing material
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Home Health/Hospice Compare
How to Use Your Data:
PEPPER:
Identify at risk claims data
Use percentile ranking to stratify risk in your compliance plan
Identify areas that are greater than 80th percentile to identify potential risk areas-this should generate audit to identify if issues present
Identify areas that agency has very low percentile ranking – this too should generate audit to identify any issues
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Knowing Your Stats:
EMR Functionality
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Clinical/Operational Reporting
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Patient demographic data Referral conversion percentage OASIS due/incomplete Outstanding orders Expiring authorizations Utilization Days to RAP/final
Financial Reporting
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When does revenue/AR get recognized?
Visit verification
Processing of a claim
Separate function
Does the EMR have the ability to report on revenue for episodic payors?
Are the reports static?
Is there a hard month close?
How do the different reports tie to one another?
What effect do different parameters have on the report data?
Productivity Reporting
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Promotes accountability
Allows for an agency to determine optimal staffing levels for all departments
Need to determine data available to track productivity Note entry
Task completion
Volume of outstanding items on clinical/operational reports
Custom Report Generation
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Significantly expands an agency’s reporting capabilities Checks and balances to existing
workflows
Exception reporting to eliminate gaps
Results in increases in productivity through the elimination of manual workarounds
Agency must know the stats and trends on which they are looking to report
Knowing Your Stats:
Benchmarking
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Clinical Benchmarks
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Visits per Day – 5-6 (weighted)
Days to RAP – 5-7 days
Days to Final Claim – 10-14 days
Visits per Episode*
SN – 7.35 (8.21)
HHA – 1.19 (2.23)
PT – 5.39 (4.59)
OT – 1.75 (1.14)
ST – 0.39 (0.21)
MSW – 0.16 (0.23)
Total – 16.23 (16.61) *Source: SHP (8/1/16 – 7/31/17)
Financial Benchmarks
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Case Mix* – 1.049 (0.975) Average Reimbursement per Episode* - $2,876 ($3,072) Gross Margin** – 38% (42%) LUPA Percentage* – 9.6% (12.2%) Outlier Percentage* – 2.8% (6.5%) Days in AR
Medicare – 30 days Non-Medicare – 60 days
Payor Mix** Medicare – 56% (60%) Managed Care/Other – 31% (30%) Medicaid – 3% (10%) *Source: SHP **Simione Financial Monitor
Cost Benchmarks
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Cost Per Visit*
SN - $96
PT - $95
OT - $99
ST - $114
MSW - $162
HHA - $42
*Source – Simione Financial Monitor
Cost Benchmarks
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Administrative and General Cost* Clinical Supervision/QI – 9.03%
Executive Team – 3.43%
Office Support – 3.03%
Intake – 2.70%
Revenue Cycle – 1.38%
IT - 1.17%
Finance - 0.96%
Medical Records - 0.63%
Human Resources - 0.46%
Fundraising - 0.46%
*Source - Simione Financial Monitor
Productivity Benchmarks
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Position Benchmark Productivity
Intake 10-20 referrals/day (dependent upon verbal orders
responsibilities)
Scheduling – Staff Entering Own
Schedules 1 staff to 400 patients
Scheduling – Staff Not Entering
Schedules 1 staff to 100 patients
Coders – Coding Only 15-20 reviews per day
Coders – OASIS review included 10-15 reviews per day
Productivity Benchmarks
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Position Benchmark Productivity
Initial IV – Medicare 50 daily Medicare admissions per FTE
Initial IV – Non-Medicare 30-35 daily Medicare admissions per FTE
Ongoing IV – Medicare 2000+ patient census per FTE
Ongoing IV – Non-Medicare 90-150 patient census per FTE
Initial Authorizations 20-25 daily admissions per FTE
Ongoing Authorizations 90-150 patient census per FTE
Productivity Benchmarks
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Position Benchmark Productivity
Orders Tracking 35 physicians called per day
Billing/Collections – Medicare Home
Health 1 staff to $15-25 million in annual revenue
Billing/Collections – Medicare
Hospice 1 staff to $25-35 million in annual revenue
Billing/Collections – Medicaid 50 claims reviewed per day
Billing/Collections – Managed Care 30 claims reviewed per day
Knowing Your Stats:
How to use your data?
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How to Use Your Data:
EMR Functionality:
Identify optimal reports to generate trending data on KPIs and benchmarks
Ensure that all departments are aware of key system functions/reporting
Develop productivity reporting for all departments
Identify functions that could be performed more efficiently outside of the EMR
Example: document management platform
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How to Use Your Data: Benchmarking:
Develop dashboard to trend KPIs
Strive to exceed the benchmark/be above average
Share benchmarks and agency goals with all departments
Proactively address issues that are resulting in negative trends
Gain an understanding of where your agency falls in comparison with like-type agencies
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Questions?
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Knowing Your Stats:
Mike Freytag – Managing Director [email protected] Brian Harris – Consulting Manager [email protected]
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